Can't sleep

I have just received a CPAP for the first time and have been trying to use it. After 7 days, I have yet to fall asleep while wearing the mask. The forced air is extremely unpleasant, and it requires a lot of force to exhale, even at the lowest settings (5). As soon as the pressure starts ramping up, it feels like there is an elephant sitting on my chest. Before I reach air pressure 6, I hit the ramp button and it drops down to 5 again. As soon as the humidifier kicks in, it feels like I am breathing through a long straw. I have to work so hard to just breathe that my heart rate shoots up to over 90 bpm. I finally end up taking off the mask just to sleep. Without the CPAP, I fall asleep in 3 minutes flat. With the CPAP, I lie in bed trying to sleep for up to an hour. Any advice?

I have a Philips DreamStation CPAP machine. The pressure starts at level 5 and can go as high as 20, according to the sleep tech. I've not been able to keep the mask on beyond level 6, so this sounds pretty improbable to me. I was given a nose-only mask that fits fine. The problem seems to be with the pressure of the airflow.

Sidesleeper. Mine was set to 5-20 and the tech reduced it to 5-15 as I have never used more pressure than 9.8 on any night. My CPAP , Res Med Air Sense 10, ramps up the pressure during Rem sleep and the high volume of air wakes me. My CPAP is supposed to reduce that air when it knows I am awake. Well, it was on Auto and still doesn't know I am awake so I tweaked that in the setting. I will find out what a mess I made of it tonight. I know how to set it back to the original settings if I messed up by my tweaking.

Since your machine is programmed to run different pressures based on your requirement, they call this mode different things on different machines but APap a set high and low range of pressure based on your particular need.

I use a full face mask but found I wanted to try a nasal mask. I tried a Wisp made by Respironics. It fit fine (came with 3 different mask parts to fit various sized faces). It didn't leak. Problem was, the mask didn't have enough exhale relief in that the holes were too small to allow me to breathe with the mask on with or without my machine being on. Went back to the full face mask (a Simplus).

Suggest you contact your med supply place and relay to them the problem you are having and request a different mask and perhaps a different type. Any mask takes some getting used to. You will figure it out!

Hi Sidesleeper. Have you tried wearing your mask before going to bed? I just mentioned in another thread that practice might be helpful. I had a similar experience to yours, and a very good Respiratory Therapist told me to take my machine out of the bedroom in the evenings and wear it while reading or watching TV. It helped me to adjust to the feeling of incoming air pressure and eventually made falling asleep much easier. Exhaling against pressure when you are not used to doing so can be very difficult. While practicing, if you find your machine ramping up the pressure, just reset the ramp to keep the pressure low until you are used to the feeling. This process might help you adjust, and you will hopefully find that it gets easier to exhale. Please keep us posted on your progress!

Hi sidesleeper, I to have a DreamStation and my pressure was originally set as 5 to 15. I couldn't do the nasal only masks at all. I had the exact same feeling of not being able to exhale. I went to full face masks also and after trying some found the Simplus to work really good for me and my pressure is now 9 to 15 and I no longer have any issues with not being able to exhale. For me I have to do the full face mask. Going to try a different style and see what happens but the Simplus works well and I'm going to always keep it around just in case.

Hi Dan. Yes, I've been using the CPAP while watching tv. I still can't get past level 6 before I feel I can't breathe at all - the pressure is too strong.
I went in to see if anything needed to be adjusted. The sleep tech checked that the mask worked well and adjusted my pressures from 5-20 down to 5-15. However, that still does not address the fact that I am having a hard time breathing against the starting pressure and that I can't sleep at all when I wear the mask.

Sleep therapy doctors and professionals address issues from the perspective of their specialty. It may help to talk to your primary care physician to get a different perspective and look at alternatives that might solve your sleep problems. I am thinking a sleep tech should be following a prescription written by a sleep doc, you may want to actually talk to the doctor; not sure a sleep tech should take it upon himself to change settings. I could be wrong on these things but perhaps a bit more professional help on this might be useful.

Hi wiredgeorge.
I was referred to the sleep doctor by my primary care doctor because she thought it might help. The issue I was referred for is a disturbed sleep pattern. If I go to bed at 10 pm, I am invariably wide awake between 1 and 4, despite being so tired I can hardly keep my eyes open. This is quite common among people with Chronic Fatigue Syndrome and nobody knows why. I also have extreme hypersensitivity when sleeping - I fall asleep quickly and easily, but wake up at every little noise. So even the hum from a so-called whisper quiet CPAP is enough to jolt me straight out of sleep and into full wakefulness. I am trying the CPAP on my sleep doctor's recommendation - she believes it will improve my CFS - but have a hard time getting past the noise of the machine and the sound of my own breathing through the mask. Struggling to breathe, especially on the exhale, is so far adding to my challenges, not reducing them. The sleep doctor tends to see everything through the perspective of apnea. I guess when your only tool is a hammer, all you see is nails.

Hi Sidesleeper. If you are having trouble exhaling against the CPAP air pressure, maybe you should talk to your sleep doctor about changing the EPR setting of your CPAP machine or possibly switching to BiPAP. EPR is "expiratory pressure relief". This setting reduces the air pressure when you are exhaling by up to 3 cmH2O. I have not used BiPAP, but my understanding is that BiPAP can reduce the air pressure even more during exhalation.

A lot going on here. I go to bed at about 10:30-11:00 PM and wake at 5AM every morning but feel pretty good so can't relate or help with the hyper-sensitivity issue as I sleep like a log. I also have 10 dogs so it is noisy at night and I wear foam ear plugs to cut down on the dog noise. Maybe ear plugs would help? By noise, I mean yapping and barking when the coyotes howl and not the lower level noises that bother you.

As far as not being able to exhale, this could be a function of the mask. I tried a WISP nasal mask and it fit great but the exhaust holes were inadequate and the mask got a lot of moisture from my breathing and I couldn't exhale. My full face mask doesn't have this issue as the exhaust capability if far greater. At some point, I am going to put a few larger holes in for exhale relief and retry. I couldn't stand to wear the thing for even short periods and could not breath at all with just the mask in place.

Hi wiredgeorge.
Thank you for your reply. I used to sleep like a log from10-11 to around 7. It was glorious.
I breathe OK using the WISP nasal mask, until the air pressure starts to build. It also helped a little when I figured out how to turn off the humidifier heater because I can't stand that warm, humid air. I will ask to try a different type of mask at my next visit.

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